Breast lumps overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Shadan Mehraban, M.D.[2]
Overview
Breast lumps are considered as one of the prevalent symptoms among women. Breast lumps can be found by individuals or clinical breast examination. Although, breast lumps are often determined as benign masses, they could be the first common presentation of breast cancer and require more clinical and imaging studies and medical interventions. Benign breast disease includes wide range of lesions which originate from either mammary epithelium or other mammary tissues. Breast lumps may be related to vascular, inflammatory or traumatic pathologies. Breast lumps are usually palpable, nodular masses and could be associated with or without particular characteristics. Breast lumps could also be found in children, adolescents and hopefully they are considered as benign tumors.The first step for evaluation of breast lumps is clinical examination then if examination was suspicious later imaging studies such as mammography, ultrasound or magnetic resonance imaging are required for further evaluation. Breast lumps management depends on disease pattern, available facilities and specialist.
Historical Perspective
Throughout the history many women experienced breast diseases but there were not any courage to express their problem to the public. In 1970s, all women with malignant breast lumps underwent radical mastectomy rather than performing previous biopsies. Although fine needle aspiration biopsy was introduce in 1930, it was used for breast lumps in 1950s. Breast ultrasound was used in 1950s and mammography was found in 1975 to diagnose early stages of breast cancers.
Classification
Breast lumps may be classified according to epithelial hyperplasia into 3 subtypes: non-proliferative, proliferative disease and proliferative disease without atypia. Breast lumps may be classified into 3 sub-types based on histological regions: lobular region, ductal region, different origins.
Pathophysiology
Breast development is influenced by different hormones such as estrogen, progesterone, prolactin, and estradiol. The pathophysiology of breast lumps depends on the histological subtypes. Histological findings of breast lumps are different from each other which lead to diagnosis. It is thought that breast lumps are the result of hormonal events and genetic mutations. Estrogen and progesterone may increase risk of benign proliferative disease to 74% and benign breast lesion in post-menopausal women receiving estrogen with or without progesteron for more than 8 years raise by 1.7 fold. Gene mutations are classified into 3 categories based on cancer risk such as BRCA1, BRCA2, TP53 considered as high risk mutations, Homozygous ataxia-telangiectasia, somatic mutation in CHEK2, BRIP1, PALB2 moderate risk mutations, and low risk genes mutation are not determined yet.
Causes
Breast lumps causes can be classified to various groups according to gender and age. Causes of female breast mass could be cancer, inflammatory, infectious, hormonal imbalance, trauma. Male breast enlargement identified as gynecomastia. Causes of gynecomastia may be multifactorial, hormonal imbalance, genetic factors, endocrine factors.Breast lumps may develop among children and adolescents, however, there are probably benign ones and related to peripubertal and pubertal phases.
Differentiating Breast lumps from Other Diseases
Breast lumps must be differentiated from other diseases such as malignancy, cysts, inflammation and non-inflammatory solid lumps. Breast symptoms such as nipple discharge and mastalgia require assessment as well.